This invention relates to the delivery of outpatient care. Specifically this invention relates to a system and method for the automated preparation and delivery of prescription medications or other controlled substances to outpatients, and to the delivery of personalized care by a single pharmacist or other professional to outpatients in multiple pharmacies.
Providing medical care to patients on an outpatient basis customarily includes the delivery of medications. It may also involve delivering controlled items, such as syringes or orthopedic aids, for example, to individuals. While these things may be provided directly by the physician, they are more typically provided by issuing a prescription to the patient. The patient then takes the prescription to a pharmacist who provides the patient with the item described in the prescription. In connection with delivering those items to the patient, the pharmacist typically offers to provide counseling to the patient as to the expected use, side effects, or drug interactions.
In addition, outpatients may also need to obtain non-prescription items which are kept in the pharmacy. One example of such an item is a cough medication containing a small amount of narcotics which must be kept in the pharmacy, so that the sale of these items can be monitored.
In a traditional arrangement, a pharmacist is generally in charge of operating a single pharmacy, either alone or in concert with other pharmacists who are responsible to the lead pharmacist. Each pharmacy generally operates as a self-contained unit, with the pharmacist in each store responsible for maintaining patient records and for assembling medications or other items for those patients. As technology has advanced there have been improvements in the methods of preparing prescriptions, including automating counting, record keeping, and similar functions. In addition, with the advent of chain pharmacies, some previously isolated records may now be merged so that an individual store, which is part of a larger commonly owned or other related group of pharmacies, has access to patient records for patients who have purchased prescription medications or other items in any of the pharmacies that are a part of the group.
Pharmacies are also increasingly located within general merchandise stores. These general merchandise stores are often open during hours when traditional pharmacies are not open. Law, or industry practice, generally requires the presence of a pharmacist any time medications are being assembled or dispensed. In order to meet customer demand for pharmaceutical services during non-traditional hours, particularly in pharmacies incorporated in stores which are open extended hours, pharmacies have hired more pharmacists than would normally be required to run a single pharmacy. Because of this, in part, the need for trained pharmacists has increased, and there is currently a critical shortage of trained pharmacists.
In contrast, increased automation of services has decreased the time it takes to fill a single prescription. In addition, the number of prescriptions being filled has not increased as dramatically as the number of hours pharmaceutical services are commonly available. Because of this, the services of individual pharmacists may not be fully utilized, even in the face of a critical shortage of trained pharmacists.
In addition to the downtime created by the increased working hours of pharmacists, without a corresponding increase in workload, a second staffing problem exists. Smaller stores, particularly those in less urban areas, are unable to compete with their massive counterparts to attract the limited number of pharmacists currently being trained. Pharmacists who might otherwise be working in small independent pharmacies are choosing to work in larger pharmacies, which can generally afford to offer higher salaries and better benefits. Unable to attract pharmacists, some of these smaller stores may be forced to stop furnishing outpatient pharmaceutical care to outpatients. This may leave individuals in some areas without adequate access to outpatient pharmaceutical services.
Thus there exists a need for a system and method for furnishing outpatient pharmaceutical services in which a single pharmacist or other professional can serve multiple pharmacies, which may be either a collection of independent pharmacies or several branches of the same pharmacy. There further exists a need for a system and method for furnishing outpatient pharmaceutical services to outpatients which uses automation and innovative technology to permit each pharmacist or other professional to serve a larger client base. There further exists a need for systems and methods that provide automated delivery of pharmaceutical services to outpatients which will permit a smaller isolated pharmacy to continue to provide pharmaceutical services without being forced to compete with larger pharmaceutical groups for the exclusive services of one of the limited number of trained pharmacists.
It is an object of an exemplary form of the present invention to provide a system and method for delivering outpatient pharmaceutical care in which a single pharmacist is responsible for providing care in multiple pharmacies.
It is a further object of an exemplary form of the present invention to provide a system and method for furnishing outpatient pharmaceutical care in which the pharmacist managing the care may do so from a location other than the pharmacy.
It is a further object of an exemplary form of the present invention to provide a system and method for furnishing outpatient pharmaceutical care in which a remote pharmacist directs one or more robots to prepare prescriptions or other controlled items locally, in secured locations.
It is a further object of an exemplary form of the present invention to provide a system and method for furnishing outpatient pharmaceutical care in which the patient may access care through a stand-alone terminal within a store.
It is a further object of an exemplary form of the present invention to provide a system and method for furnishing outpatient pharmaceutical care in which the patient may access care through a drive-through terminal on the exterior of a store.
It is a further object of an exemplary form of the present invention to provide a system and method for furnishing outpatient pharmaceutical care with more accuracy than a traditional system by using automated mandatory verification before delivering the medication or other item to the patient.
It is a further object of an exemplary form of the present invention to provide a system and method for furnishing outpatient pharmaceutical care which provides increased assurance that each patient will be offered patient counseling with each item dispensed.
It is a further object of an exemplary form of the present invention to provide a system and method for furnishing outpatient pharmaceutical care which results in more effective counseling of patients by using a larger or multiple database of patient information.
It is a further object of an exemplary form of the present invention to provide a system and method for pharmaceutical outpatient care which results in more effective counseling of patients by using a systematically generated list of concerns that specifically relate to an individual patient and/or the item prescribed.
Further objects of exemplary forms of the present invention will be made apparent in the following Best Modes for Carrying Out Invention and appended claims.
The foregoing objects are accomplished in an exemplary embodiment which permits a single pharmacist or other professional who can deliver prescription medications, who will be referred to herein as a xe2x80x9cpharmacist,xe2x80x9d to simultaneously serve several individual pharmacies. In an exemplary embodiment a pharmacist will generally work at a location that is remote from most or all of the individual pharmacies being served. In order to accomplish this, the remote pharmacist will be in direct computer connection, over a network, with each of the individual pharmacies being served. Through this network, the pharmacist will be connected with user service stations, drug vaults, and a customer service computer located within each individual pharmacy. The connection will include CCTV connections to each of these locations within the individual pharmacies, permitting the pharmacist to observe a robot or other device preparing prescriptions in the drug retrieval vault and in the drug compounding vault, and to communicate directly with customers and local technicians.
In an exemplary embodiment, the pharmacist""s computer is adapted to permit the pharmacist to control the robots in one or more drug vaults from a remote location. The remote pharmacist is in interactive communication with the robots in the individual pharmacies as the robots prepare the items that are to be dispensed to each customer.
In an exemplary embodiment of a pharmacy the remote pharmacist will have access to one or more processing and data storage devices containing individual patient histories for the group of pharmacies he or she serves, general information about the drugs which may be dispensed, the rules that apply to the various insurance plans accepted by each pharmacy, persons registered to prescribe medications, and the items stocked in each location. These data storage and processing devices may be in the same physical location as the remote pharmacist, or the pharmacist may be connected to these devices through one or more networks. The network used in an exemplary embodiment is separated from any external network by a pharmacist""s computer which includes a firewall, or other means to prevent unauthorized access.
Each of the individual pharmacies served by a remote pharmacist is equipped with an automated drug preparation and compounding area, and may have one or more self-service customer terminals through which the patient can access pharmaceutical services. The individual pharmacies may also have a traditional customer service area, which is staffed by an individual. A computer in each local pharmacy controls and coordinates the network within that pharmacy. It includes a firewall or other means to prevent unauthorized access. Each of the individual pharmacies is connected to a remote pharmacist via a computer network system.
Customer terminals, if they are part of an embodiment of an individual pharmacy, may be walk-up terminals inside the store or drive-through terminals on the outside of the pharmacy. Customer terminals include a way for the patient to submit a prescription to be filled, to communicate with the pharmacist, to pay for the prescription, and to take delivery of the prescription. These functions may all be contained in a single customer terminal or split between two or more customer terminals. Some of the functions of a customer terminal will be performed using (1) dedicated input devices, such as a card reader, a prescription scanner, or a bar code reader; (2) dedicated output devices, such as printers adapted to print drug information sheets and receipts; and (3) interactive communication devices, such as Closed Circuit Television (xe2x80x9cCCTVxe2x80x9d), and intranet or internet connections. Most customer terminals will also include access to a pneumatic delivery system, which connects the parts of the local pharmacy so that objects can be sent between them.
An exemplary embodiment of the drug preparation area will generally include two vaults in which robots prepare the items requested. An exemplary embodiment of the first vault will include storage cells around the walls of the vault. These storage cells will contain the medications or medication components most commonly used in a particular pharmacy, and other items that must be dispensed through the pharmacy. Such an embodiment will also include a preparation area that includes various automated counting or measuring devices.
In the exemplary embodiment a relatively simple robot is located within the drug retrieval vault. The robot is adapted to perform one or more tasks necessary to prepare simple pharmaceutical orders. The robot is also adapted to perform one or more tasks necessary to deliver the raw ingredients for more complicated pharmaceutical orders to the drug compounding vault. Finally, the robot is adapted to package and deliver the prepared pharmaceutical order to the customer. Actions of the robot are directed by a pharmacist from a remote location.
In addition, an exemplary embodiment of a pharmacy using the system and method of this invention includes a drug compounding vault. This vault is used to prepare medications which cannot be delivered to the patient in the form in which they are stored in the pharmacy. The compounding performed may be minor, such as mixing water with a powder just before the medication is delivered to the patient. It may also be more complex, such as preparing an individualized medication from several ingredients.
An exemplary embodiment of a drug compounding vault includes the various devices that a pharmacist would need to compound drugs. The exemplary drug compounding vault is in direct connection with the drug preparation vault via a pneumatic delivery tube. An exemplary embodiment may also include a sophisticated medical robot, equipped with various sensor devices similar to those used in surgical robots.
An exemplary robot in an exemplary drug compounding vault is adapted to perform complex manipulations with raw ingredients, using traditional compounding tools, at the direction of a remote pharmacist. The robot is also adapted to retrieve ingredients sent to it by the robot in the drug retrieval vault and to return the compounded pharmaceutical item to the robot in the drug retrieval vault.
An exemplary embodiment of a pharmacy may also include a traditional customer service desk at which an individual may speak directly with a technician. In an exemplary embodiment of a system including this feature, the technician will gather the information from the patient, and transmit it to the remote pharmacist, using devices that may be similar to those available to the customer at a customer terminal. The look and feel of the interaction at a customer service desk will generally be similar to the look and feel of a traditional pharmacy interaction, with the exception that patients will receive counseling over the CCTV rather than face-to-face.
In addition, in an exemplary embodiment of a pharmacy using this method, a prescriber or a customer may use the telephone to request pharmaceutical care. Depending on the laws of the state, the technician at the service desk will either transmit the prescription in the form of an audio or digital recording to the remote pharmacist or will enter the information into the pharmacy computer which will then transmit it in facsimile form to the remote pharmacist. The system may also be configured to accept direct computer-to-computer transmissions of prescriptions from individual prescribers.